Britain’s NHS risks taking longer to recover from the coronavirus crisis than health services in many comparable countries, reflecting years of underfunding, a high Covid-19 death toll and a lack of investment in care outside hospitals, a new report suggests.
The findings from the Nuffield Trust, a London-based think-tank, shared with the Financial Times, offer the most detailed account yet of how different health systems have performed during the pandemic. None has been left unscathed and all are dealing with backlogs of postponed treatment.
However, the UK had “higher occupancy rates and fewer doctors, nurses, beds and capital assets than most other high-income health systems”, when the crisis struck, the researchers said.
“It’s clear that the NHS entered the pandemic with very few advantages in terms of capacity and resources compared to other high-income countries,” said Sarah Reed, senior policy fellow, who led the work for the trust.
The report focuses on 16 OECD or EU member countries, including Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Israel, the Netherlands, Malta, Portugal, Spain and Sweden. Experts from New Zealand were also interviewed.
“Countries with greater pre-existing capacity and that have more effectively contained coronavirus are likely to be in a better position to cope with care backlogs arising from the pandemic and recover from its consequences,” the trust said.
The UK is raising national insurance contributions from next month to help boost funding for the health service and social care sector. The move will generate an additional £ 36bn over the next three years. Ministers are also increasing capital spending for England’s NHS by just over £ 1bn by 2024/25.
But the trust questioned whether the investments “will be sufficient to not only meet ongoing demands but also to flexibly surge capacity when needed – in terms of both acute and intensive care beds and the health workforce to staff them”.
Waiting lists for treatment have been rising in the NHS long before the pandemic but have since grown by 35 per cent, with more than 6mn people now waiting for care. It remains unclear how many who held off seeking treatment during the crisis will now do so, and how far their conditions may have worsened.
The report makes it clear that all the countries studied are grappling with the consequences of treatment delayed during the pandemic. In some – including Spain, Italy and Portugal – “waiting lists appear to be stabilizing or even decreasing in areas as treatment activity reaches or exceeds historical levels”, it said. But data suggested this may be due to fewer referrals being received from primary care as patients avoided seeking help out of concerns over the virus or had difficulty securing appointments, the researchers said.
In the Netherlands, waiting lists have returned to pre-pandemic levels in several key areas, but experts warned that there could be pent-up demand as there had been 1.48mn fewer referrals between March 2020 and August 2021.
Patrick Jeurissen, a professor of health economics at Radboud University, Nijmegen, who advised the Dutch Ministry of Health, told the FT that although the country’s health service was now operating with “regular capacity now again close to what’s normal. . . that doesn’t mean that waiting lists are gone because, of course, there were quite some months when the healthcare sector was performing substantially below regular capacity ”.
The report underlines that countries that managed to keep treatment going more successfully than the UK did so in part because they had invested more in facilities for rehabilitation and “step down” care, sparing beds for those who really needed them.
Reed said there seemed to be “an explicit appreciation in lots of other countries” that hospital backlogs could not be eroded if general practice, social care, community care and mental health services were not able to recover from the shock of the crisis.
“Pressures in one part [of the system] end up in another and I think there is a real acknowledgment in other countries that if we’re going to reduce wait times, a lot of that depends on being able to manage and treat patients outside the hospital, ”she said.
Nigel Edwards, Nuffield Trust chief executive, pointed out that while the Netherlands had reduced bed numbers by a similar amount to the UK in recent years, it had invested far more into building “a very substantial, powerful homecare sector”. As a result, it did not have the same problem of “delayed discharges” as Britain, when people who are medically fit to go home cannot be released because of the lack of support in the community. “It’s given them more flexibility,” he added.
The distribution of beds was also significant, according to Edwards. In Germany, which had more hospitals than the UK, it had been easier to separate non-emergency “elective” work from urgent treatment, ensuring that routine surgery was not disrupted by emergencies during the pandemic.
The time patients remain on a ward has also been crucial to countries’ ability to manage the crisis and its aftermath. In Denmark, for example, there was a similar number of beds per population as the UK but a far shorter length of stay.
Dr Jørgen Schøler Kristensen, chief medical officer at Aarhus University Hospital, one of the country’s largest, said Denmark had reduced hospital beds by 25 per cent since 2014 but had simultaneously increased numbers of doctors and nurses. “And that meant we had no spare beds because our beds are full all the time,” he said.
But he added that quick assessments and prompt treatments meant people were able to return quickly to their own homes or into well-supported local social care systems. “So there were no patients actually accumulated in the hospital, which was very beneficial,” he said.
Edwards said the NHS has been implementing a number of measures designed to ease pressure on hospitals, including investing in diagnostic hubs where people can receive scans in the community, and it has promised to review general practice. “It looks like the components are being assembled but I don’t think we’ve yet got a complete coherent joined-up strategy. So they might want to hurry up, ”he said.
The Department of Health and Social Care said: “We have set out the biggest NHS recovery plan in history backed by unprecedented investment which – combined with record numbers of doctors and nurses working in the NHS – will reduce waiting times, give patients more control over their care, and harness technology to free up staff.
“We are also reforming the social care system by providing £ 5.4bn of investment and delivering better integration with the NHS so people receive the right care in the right place at the right place at the right time.”
Data and visuals by Federica Cocco